Medicare Plans Iowa

Coverage and Benefits

Any Iowa resident age 65 or older should enroll in the federal Medicare program. Once you enroll, you’ll receive medical coverage benefits from Parts A and B of the Medicare program. Parts A (for hospital stays) and B (for regular doctor visits) are designed to help you manage most of your health care costs. The goal of Medicare is to be comprehensive, so that retirement-age citizens don’t have to worry about expensive health care costs or medical treatment. Unfortunately, there are “gaps” in Original Medicare coverage. If you aren’t careful, they could end up breaking your bank.

Everyone with Original Medicare will pay a monthly premium and an annual deductible for Part B (prices are shown here). Part A might be free – if you have a long enough employment history. The minimum requirement is 10 years, or 40 quarters. Anything less than that, and you could be paying some fairly expensive premiums in order to get access to your Part A benefits.

For more information on Original Medicare, see the table below:

Medicare Part A (Hospital Coverage)

Inpatient care in hospitals

Skilled nursing facility care

Hospice care

Home health care

Medicare Part B (Medical Insurance)

Services from doctors and health providers

Outpatient care

Home health care

Durable medical equipment

Some preventive services

Medicare Part C (Medicare Advantage)

Includes all benefits and services covered under Part A and Part B

Usually includes Medicare prescription drug coverage (Part D) as part of the plan

Run by Medicare-approved private insurance companies

May include extra benefits and services for an extra cost

Medicare Part D (Drug Coverage)

Helps cover the cost of prescription drugs

Run by Medicare-approved private insurance companies

May help lower your prescription drug costs and help protect against higher costs in the future

Medicare Insurance Programs in Iowa

At this moment, there are more than half a million people (531,209 to be specific) receiving some form of Medicare benefits within the state of Iowa. Of those, 14% (or 74,369 people) have a Medicare Advantage plan, which we will explain in greater detail later. A significant 48% of Iowa residents (252,843 people) have Original Medicare, and are also supplementing it with a Medigap policy. We will discuss Medigap policies in greater detail also. The remaining 38% of Iowa Medicare beneficiaries either have employment benefit policies which are supplementing their Medicare policies, or they are relying upon Traditional Medicare alone to help cover their health care needs.

Why do so Many Iowa Residents Buy a Supplement?

Health care expenses have risen sharply over the past several years. Despite government attempts to make Traditional Medicare as comprehensive as possible, there are still gaps in coverage which require you alone to pay the difference. And if your health care needs fall through one of these coverage gaps, you could end up paying:

Medicare Part A Costs

Medicare Part B Costs

$1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services

Fortunately, there are a number of flexible and affordable options when it comes to supplementing Medicare with an additional or an alternate insurance policy. The two most common supplements are Medicare Advantage (sometimes called Medicare Part C), and Medigap insurance (because it is designed to cover the “gaps” in Medicare). Keep reading for more information on each plan, and to learn why they are so popular.

Medigap Supplement Insurance in Iowa

For simplicity’s sake, each one of the ten available Medigap policies are assigned a letter of the alphabet in order to identify them: Plans A, B, C, D, F, G, K, L, M, and N are currently available for purchase in all 50 states. Plans E, H, N, and I are no longer available due to the Medicare Modernization Act of 2010. Plan A in Iowa offers the exact same coverage and benefits as Plan A in California; however, it will likely be cheaper in your state. You will may also have several different underwriters to choose from.

Here are the coverage and benefits options for each plan:

Plans

A

B

C

D

F

G

K

L

M

N

Part A Hospital Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Hospital Reserve Days

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Benefit For Blood

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Part B Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

*Co-Pays

Hospice Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Skilled Nursing Facility

✖

✖

✓

✓

✓

✓

50%

75%

✓

✓

Part A Deductible

✖

✓

✓

✓

✓

✓

50%

75%

50%

✓

Part B Deductible

✖

✖

✓

✖

✓

✖

✖

✖

✖

✖

Part B Excess Charges

✖

✖

✖

✖

✓

✓

✖

✖

✖

✖

Foreign Travel Benefit

✖

✖

✓

✓

✓

✓

✖

✓

✓

✓

Preventive Care Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Out of Pocket Limit

None

None

None

None

None

None

$4,620

$2,310

None

None

Co-Pays are $20 per office visit, and $50 per ER visit if not admitted to a hospital.** A checkmark indicates 100% coverage for the specified benefit.

Iowa Medicare Advantage

If you would like to switch from receiving government Medicare to receiving identical Medicare coverage and benefits from a private health insurance company, then you might want to consider a Medicare Advantage policy. Federal law requires these policies to provide “equal or greater” benefits when compared with Traditional Medicare so that you don’t put yourself at too much of a disadvantage by relying on a private company to help manage your health care needs. Sometimes, Medicare Advantage policies offer extra benefits, like vision or dental, for a minimally higher cost.

One of the ways in which Medicare Advantage policy costs are kept low is via restricted networks. The companies are picky about which doctors and physicians they choose to allow into their HMO and PPO networks, so the doctor you may be seeing now might not be available to you if you switch to a Medicare Advantage plan. This is an important factor to keep in mind if you are thinking about purchasing such a policy.

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are special groups of doctors, hospitals, and facilities through which Medicare Advantage plans provide you with care. Here are some HMO and PPO networks near you:

Top HMO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$0

Coventry Advantra Silver (HMO)

Health and Drug

$0.00

$0

$0

Coventry Total Care (HMO)

Health and Drug

$0.00

$0

$0

AARP MedicareComplete Plan 3 (HMO)

Health and Drug

$0.00

$0

Top PPO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$0

Coventry Advantra Platinum (PPO)

Health and Drug

$0.00

$0

$0

HumanaChoice H5868-004 (PPO)

Health Only

$0.00

$0

$444

HumanaChoice H5868-001 (PPO)

Health and Drug

$37.00

$310

For Iowa: Comparing Medigap and Medicare Advantage

There is a lot you need to know about the differences between these two forms of coverage. Read the following table carefully, and make sure to take note of how dissimilar these plans actually are:

Questions

Medicare Advantage

Medicare Supplement

How are the plans funded?

Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.

Your monthly premium takes care of the majority of your expenses.

Do I continue paying for Part B?

Yes

Yes

What does it cost me?

Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.

While each plan does require a monthly premium, many of them are affordably priced.

What does the plan cover?

Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.

All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.

Can I budget my health care expenses?

It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.

Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.

Can my plan be cancelled?

Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.

No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.

Are pre-approvals or pre-certifications required?

Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.

No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.

Can I use any doctor or hospital?

Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.

Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.

Can drug, vision, or dental coverage be included in the policy?

Yes.

No. These forms of coverage must be purchased separately.

Who is this plan type generally best suited for?

If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.

If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Informative Resources in Iowa

If you still have questions, don’t worry. It’s perfectly normal. Your next step is to have those questions answered by the Medicare professionals near you who know how to provide you with the answers you seek. Consult the following directory, and make sure you get in touch with those who can point you in the right direction.

Important Medicare-Related Healthcare Terms

HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.

PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.

Co-Pay: Amount of money charged per visit to doctor, specialist, etc.

Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.

Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.